House Legislation Mandates Switch to ICD-10 by 2009

Coalition Urges Doctors to Ask Congressional Representatives to Put Brakes on the Provision

The U.S. House of Representatives is expected to vote this month on a bill (H.R. 4157) that would require all health care payers and providers, including doctors of chiropractic, to switch from the current ICD-9 code set to a new and greatly expanded ICD-10 code set by Oct. 1, 2009. Some in health care worry that the deadline is too soon and that providers won’t have the time necessary to learn and adjust their office systems to the vast array of new codes.

The legislation, also known as the “Health Information Technology Promotion Act of 2005,” is designed mainly to promote the national adoption and standardization of electronic medical records. Rep. Nancy Johnson (D-Conn.), author of the House version, added the deadline for transition to ICD-10—a move supported by hospitals and software makers. Published by the World Health Organization, ICD codes, describe known diseases and injuries, and are used to collect statistics on morbidity/mortality and to reimburse services.

Opposing the timing of such a change is a coalition of insurance and provider groups, which fears that a hasty transition to ICD-10 would be problematic and put the receipt of timely Medicare and private health insurance payments at risk.

Members of the coalition, which include Blue Cross Blue Shield, Aetna, and the American College of Physicians, say the transition to ICD-10 will be a massive and costly undertaking and that providers and payers cannot prepare adequately for it in only three years—especially since many are still implementing other HIPAA mandates and beginning to apply for the national provider identifier, among other changes.

The new code set would require providers to be much more specific when describing their services. For example, the current single ICD-9 code for "striking against or struck accidentally in sports without subsequent fall" will be replaced by 24 possible ICD-10 codes. Providers would have to determine precisely what object struck the patient: a football, soccer ball, golf ball, shoe cleat, field hockey stick, etc.

Altogether, the number of diagnostic codes would jump from 13,000 under ICD-9 to 120,000 under ICD-10—almost a ten-fold increase.

The coalition believes providers need more time to understand and prepare for the major changes to their practices that ICD-10 will entail:

·Overhauling clinical, financial, analysis, scanning and billing systems to handle the thousands of new codes.Estimates show that this will cost outpatient providers up to $2.2. billion to complete;

·Acquiring and becoming proficient (both doctors and staff) with technology needed to sort through and triage the numerous decisions necessary to code properly and be paid in a timely manner;

·Renegotiating payer contracts, because many are based on code definitions and their associated reimbursement rates.

Furthermore, the coalition points out that before any change is made, the health care industry must first move to a new version of HIPAA transactions—5010—because the current 4010 version is not compatible with ICD-10.

DCs are urged to contact their U.S. senators and representatives to request additional time on the implementation of ICD-10 either by voting against H.R. 4157 or by introducing an amendment that would give all physicians ample opportunity to adjust their documentation. Contact your members of Congress by calling the Capitol switchboard at (202) 224-3121.